Brief Alerts: Diathermy Plus Deep Brain Stimulation can Destroy Brain Regions
Brief Alerts
Diathermy Plus Deep Brain Stimulation can Destroy Brain Regions
Source: Nutt JG, et al. Neurology. 2001;56:1384-1386.
A 70-year-old man developed severe parkinson’s disease (PD) at age 50 and at age 68 had quadripolar activating electrodes placed in the subthalamic nucleus. Moderate improvement in his PD ensued and he reduced his dopaminergic drugs 19 months following the implantation. Subsequently, he had his maxillary teeth extracted because of chronic alveolar osteonecrosis. The following day a diatherm induction coil was applied successively for 30 minutes on each cheek in an effort to accelerate gum repair. Coils were set at 95-µ pulses at 4000 Hz and a power setting of 10. After the first 39 minutes he became drowsy and after the second segment coma reigned. Clinical findings included small pupils, roving eye movements, and decrebrate posturing. MRI scanning 3 days later indicated T2 segmental abnormalities said to affect the pointine and mid brain areas plus the cerebral peduncles. An MRI obtained 32 days after the catastrophe indicated a reduction of the T2 lesions to the area of the electrodes in the subthalamic nucleus. The previously identified mesencephalic and pontine abnormalities had disappeared, which is to be expected since those areas directly regulate eye movements, a function the patient had never lost. At 50 days after onset, he appeared to possess only unchanging minimal awareness.
Nutt and associates believe that the patient’s catastrophe may have developed due to heated electrodes from the maxillary placement of the diathermy. They suggest that the RF current transpassed through the base of the skull into the brain and may have been the accident that produced this distressing result. Whatever the mechanisms of this focal heat stroke, diathermy neighboring near steel electrodes is dangerous therapy. —Fred Plum
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.